| NPI | 1548750003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: GA 8649) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA 8649) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2020-01-20 |